Uji daya hambat sediaan tetes telinga ekstrak daun “Tebel-Tebel” (Hoya carnosa) terhadap bakteri gram positif dan gram negatif penyebab Otitis Media Supuratif Kronik (OMSK) aktif tipe benigna secara in-vitro di RSUP Sanglah, Bali, Indonesia

Background: The recent Chronic Suppurative Otitis Media (CSOM) management by antibiotic Chloramphenicol 1% ear drop seems to be ineffective due to the bacterial resistance, ototoxic effects, and the idiosyncratic response. Traditional medicine from Hoya carnosa leaf as ear drops has been suggested for alternative medicine because of its antibacterial properties. This study aims to evaluate the inhibition test of Hoya carnosa leaf-extract towards gram-positive and gram-negative bacteria cause

Methods: An experimental study with a completely randomized post-test control group design has been conducted to the American Type Culture Collection (ATCC), which consists of Staphylococcus aureus, Streptococcus pyogenes, Pseudomonas aeruginosa dan Enterobacter spp. The Hoya carnosa leaf extract in-ear drop emulsion has been divided into 3 concentrations, such as 1%, 3%, and 5% w/v by simple random technique. As a positive control used Chloramphenicol 1% and as a negative control using 96% ethanol. Each treatment was repeated 5 times and data were analyzed by SPSS version 17 for Windows.

Results: There was a significant difference in inhibitory diameter (IH) from ear drop dosage of (Hoya carnosa) leaf emulsions to Streptococcus pyogenes bacteria in concentrations of 3% and 5% (p<0.05). There was a significant difference from the inhibitory drug resistance (DDH) ear drop emulsion preparation leaf extract "tebel-tebel" (Hoya carnosa) concentrations of 1%, 3% and 5% with Cholrampenicol 1% against Streptococcus pyogenes bacteria (p<0.05)

Conclusion: There was a significant difference in inhibitory diameter (DDH) and inhibitory drug resistance from Hoya carnosa leaf emulsions ear drops to Streptococcus pyogenes bacteria.

Latar Belakang: Penatalaksanaan Otitis Media Supuratif Kronis (OMSK) saat ini dengan antibiotik Kloramfenikol tetes telinga 1% tampaknya tidak efektif karena adanya resistensi bakteri, efek ototoksik, dan respon idiosinkratik. Obat tradisional dari daun Hoya carnosa sebagai obat tetes telinga telah disarankan untuk pengobatan alternatif karena sifat antibakterinya. Penelitian ini bertujuan untuk mengevaluasi uji daya hambat ekstrak daun Hoya carnosa terhadap bakteri penyebab gram positif dan gram negatif

Metode: Telah dilakukan penelitian eksperimental dengan rancangan acak kelompok kontrol post-test pada American Type Culture Collection (ATCC) yang terdiri dari Staphylococcus aureus, Streptococcus pyogenes, Pseudomonas aeruginosa dan Enterobacter spp. Ekstrak daun Hoya carnosa dalam emulsi tetes telinga dibagi menjadi 3 konsentrasi yaitu 1%, 3% dan 5% b / v dengan teknik acak sederhana. Sebagai kontrol positif digunakan Kloramfenikol 1% dan sebagai kontrol negatif menggunakan etanol 96%. Tiap perlakuan diulang sebanyak 5 kali dan data dianalisis dengan SPSS versi 17 untuk Windows.

Hasil: Terdapat perbedaan bermakna dalam uji diameter daya hambat (DDH) antara dosis tetes telinga emulsi daun Hoya carnosa terhadap bakteri Streptococcus pyogenes pada konsentrasi 3% dan 5% (p <0,05). Ada perbedaan yang bermakna antara ekstrak daun “tebel-tebel” (Hoya carnosa) sediaan emulsi tetes telinga konsentrasi 1%, 3% dan 5% dengan Cholrampenicol 1% terhadap bakteri Streptococcus pyogenes (p <0,05).

Kesimpulan: Ada perbedaan yang bermakna pada diameter hambat (DDH) dan resistensi obat penghambat emulsi daun Hoya carnosa tetes telinga terhadap bakteri Streptococcus pyogenes.

Gambaran pola makan, kecukupan gizi, dan status gizi mahasiswa Fakultas Kedokteran Universitas Mataram, Nusa Tenggara Barat

Background: Nutritional problem is a problem that still faced by developed countries and developing countries. An unbalanced diet is one of the causes of nutritional problems. Several studies have shown that students have an unhealthy diet and eating habits. Several factors influences such as high academic activity, limited food choices around the campus, and choosing food at affordable prices. This study aims to determine the eating pattern, nutrition adequacy, and nutritional status of the students in the Medical Faculty of Universitas Mataram, Mataram, West Nusa Tenggara, Indonesia.

Methods: This descriptive-analytical study involving students of the Medical Faculty of Universitas Mataram who met the inclusion and exclusion criteria as subjects. Subjects were obtained using a consecutive sampling method. Measurement of dietary and nutritional adequacy using a 24-hours food recall questionnaire and NutriSurvey software, and calculation of nutritional status based on body mass index (BMI).

Results: A total of 88 students were included in this study. Students with proper and improper diet pattern were 38 (43.18%) and 50 (56.82%). Students with sufficient nutrition were 42 (47.73%), and 46 (52.27%) were lack of adequate nutrition. Based on the nutritional status, 18 (20.45%) were underweight, 58 (65.91%) were normal, 8 (9.09 %) were overweight, and 4 (4.54%) were obesity.

Conclusion: Most students have improper eating patterns, lack of adequate nutrition, and normal nutritional status.

Latar belakang: Masalah gizi berupa kekurangan dan kelebihan gizi masih menjadi masalah baik di negara berkembang maupun negara maju. Masalah gizi ini dapat disebabkan adanya pola makan yang tidak seimbang. Beberapa penelitian menunjukkan bahwa mahasiswa memiliki pola makan dan kebiasaan makan yang tidak sehat, karena pengaruh beberapa faktor seperti kesibukan akademik, pilihan makanan yang terbatas di sekitar kampus, dan memilih makanan dengan harga yang terjangkau. Penelitian ini bertujuan untuk mengetahui gambaran pola makan, kecukupan gizi, dan status gizi mahasiswa Fakultas Kedokteran Universitas Mataram, Nusa Tenggara Barat

Metode: Penelitian ini adalah penelitian analitik deskriptif dengan desain potong-lintang. Subjek penelitian adalah mahasiswa Fakultas Kedokteran Universitas Mataram yang memenuhi kriteria inklusi dan eksklusi. Subjek penelitian diperoleh dengan menggunakan metode consecutive sampling. Pada subjek dilakukan analisis pola makan dan kecukupan gizi menggunakan kuisioner 24-hour  food recall  dan software NutriSurvey, serta perhitungan status gizi  berdasarkan indeks massa tubuh (IMT).

Hasil: Sebanyak 88 mahasiswa diikutsertakan dalam penelitian ini. Terdapat 38 mahasiswa (43,18%) dengan pola makan yang benar dan 50 mahasiswa (56,82%) dengan pola makan yang salah. Terdapat 42 mahasiswa (47,73%) cukup gizi dan 46 mahasiwa (52.27%) berada pada angka kecukupan gizi kurang. Untuk status gizi, 18 mahasiswa (20,45%) dengan status gizi kurang, 58 mahasiswa (65,91%) dengan status gizi normal, 8 mahasiswa (9,09%) dengan status gizi berat badan lebih, dan 4 mahasiswa (4,54%) dengan status gizi obesitas.

Simpulan: Pola makan mahasiswa sebagian besar masih kurang tepat, angka kecukupan gizi sebagian besar kurang. Sebagian besar mahasiswa mempunyai status gizi normal.

Korelasi antara parameter faal hemostasis dan kadar serum laktat sebagai indikator mortalitas pada pasien multiple trauma di Rumah Sakit Umum Pusat Sanglah Denpasar, Bali-Indonesia

Background: Trauma is now the most frequent cause of death in the first four decades of life and is still a major public health problem in every country. Trauma that occurs often involves several regions of the body. This condition is called multiple trauma. In multiple trauma, coagulopathy often occurs. In the last four decades it was mentioned that in multiple trauma conditions also occur acidosis and coagulopathy which will also increase the mortality of multiple trauma patients with multiple trauma, serum lactate is superior to base deficit. The purpose of this study is to obtain the correlation of each prothrombin time (PT) value, activated partial prothrombin time (aPTT) value and international normalized ratio (INR) value with serum lactate levels as indicators of mortality in multiple trauma cases.

Methods: This study was an observational study with an analytic cross-sectional design to determine the correlation between physiological parameters of hemostasis and serum lactate in multiple trauma patients.

Results: From the 60 samples studied there were 43 male patients (71.7%) and 17 female patients (28.3%) with an average age of 37 ± 19.61 years. 7 (11.7%) cases died. Logistic regression test with each conducted on the APPT and INR variables and lactate levels obtained aPTT was the most influential risk factor for mortality with a p-value of 0.005 <0.05 OR 0.023 (CI 95%: 0.002-0.332)

Conclusion: Serum lactate levels and physiological hemostasis are not only indicators that explain a patient in a state of shock, but can also be used as an indicator in determining morbidity and mortality in multiple trauma patients.

Latar belakang : Trauma saat ini merupakan penyebab kematian paling sering dalam empat dekade pertama kehidupan dan masih menjadi masalah kesehatan masyarakat yang utama di setiap negara. Trauma yang terjadi seringkali melibatkan beberapa regio tubuh. Kondisi ini disebut dengan multipel trauma. Pada multipel trauma, sering terjadi koagulopati.  Pada empat decade terakhir disebutkan bahwa pada multipel trauma juga terjadi keadaan asidosis serta koagulopati yang juga akan meningkatkan mortalitas pasien multipel trauma multipel trauma, serum laktat lebih superior dibanding defisit basa. Tujuan dari penelitian ini adalah didapatkan korelasi masing – masing nilai prothrombin time (PT), nilai activated partial prothrombin time (aPTT) dan nilai international normalized ratio (INR) dengan kadar serum laktat sebagai indikator mortalitas pada kasus multipel trauma.

Metode: Penelitian ini merupakan studi observasional dengan rancangan potong lintang analitik untuk mengetahui korelasi antara parameter faal hemostasis dan serum laktat pada pasien multiple trauma.

Hasil: Dari 60 sampel yang diteliti dijumpai penderita laki-laki sebanyak 43 orang (71,7 %) dan perempuan 17 orang (28,3 %) dengan rata-rata usia 37 ± 19,61 tahun. Penderita yang meninggal sebanyak 7 (11,7%)  kasus. Uji regresi logistik dengan masing masing dilakukan pada variabel APPT dan INR serta kadar laktat didapatkan aPTT merupakan faktor risiko yang paling berpengaruh terhadap terjadinya mortalitas dengan p-value 0,005 < 0,05 OR 0,023 (IK: 0,002-0,322)

Simpulan: Kadar serum laktat dan faal hemostasis tidak hanya sebagai indikator yang menerangkan pasien dalam keadaan syok, tapi juga dapat digunakan sebagai indikator dalam menentukan morbiditas dan mortalitas pada pasien multipel trauma.

Faktor-faktor risiko yang berperan terhadap terjadinya infeksi luka operasi pada pasien post appendectomy di RSUP Sanglah Denpasar

Background: Surgical wound infection (SWI) is one of the three most common hospital-acquired infections, with an average of 14-16% and which is the most common infection in postoperative patients. This study aims to look for factors associated with post-operative wound infection in the appendectomy procedure at Sanglah General Hospital Denpasar.

Methods: This study used a retrospective cohort design, which was carried out at the Medical Record Installation Sanglah General Hospital Denpasar, Bali-Indonesia during the January 2017 to September 2018. Data analysis used chi-square tests, relative risk calculations, and logistic regression.

Results: This study used 108 respondents, and there were 17 people who experienced SWI, the final analysis using logistic regression showed a diagnosis of perforated appendicitis (RR: 9.57; 95% CI: 2.09-43.64; p = 0.004) and operator guidance resident (RR: 1.75; 95% CI: 1.49-22.3; p = 0.011) is a risk factor for the occurrence of the SWI.

Conclusion: The diagnosis of perforated appendicitis is the most important factor in the occurrence of surgical wound infection after appendectomy.

Latar Belakang: Infeksi luka operasi (ILO) merupakan salah satu dari tiga infeksi tersering yang didapat di rumah sakit, dengan rata-rata mencapai 14-16% dan yang merupakan infeksi yang paling sering terjadi pada pasien pasca operasi. Penelitian ini bertujuan untuk mencari faktor-faktor yang berhubungan dengan infeksi luka operasi pasca prosedur appendectomy di RSUP Sanglah Denpasar.

Metode: Penelitian ini menggunakan rancangan kohort retrospektif, yang dilakukan di Instalasi Rekam Medis RSUP Sanglah Denpasar, Bali-Indonesia selama periode Januari 2017 hingga September 2018. Analisis data menggunakan uji chi-square, perhitungan risiko relatif, dan regresi logistik.

Hasil: Penelitian ini menggunakan 108 responden, dan terdapat 17 orang yang mengalami ILO, analisis akhir menggunakan regresi logistik menunjukkan diagnosis appendisitis perforasi (RR: 9,57; IK 95%: 2,09-43,64; p=0,004) dan operator residen bimbingan (RR: 1,75; IK 95%: 1,49-22,3; p=0,011) merupakan faktor risiko terjadinya ILO.

Simpulan: Diagnosis appendisitis perforasi merupakan faktor yang paling berperan terhadap terjadinya infeksi luka operasi pasca appendectomy.

Gambaran prevalensi penderita sifilis laten, sekunder, dan primer pada pasien Infeksi Menular Seksual (IMS) di Poliklinik Kulit dan Kelamin RSUD Mangusada, Badung, Bali periode 2017 – 2018

Background: Venereal disease (syphilis) has long been known in Indonesia. However, the clinical manifestations of syphilis differ according to the stage in which they affect the treatment plan. Therefore, this study aims to determine the prevalence of latent, secondary and primary syphilis in sexually transmitted infections (STI) patients in the Skin and Venereal Polyclinic of Mangusada Regional Hospital, Badung.

Methods: A cross-sectional observational study was conducted on secondary data from the medical records of Syphilis patients at the Mangusada Badung Hospital & Gynecology Clinic in January 2017-December 2018 using a total sampling technique. Syphilis prevalence in patients mainly from gender and clinical manifestations of syphilis are noted in this study. The data obtained were analyzed descriptively with SPSS software version 20 for Windows.

Results: Total visits of cases of sexually transmitted infections (STI) were recorded as many as 332 people where syphilis cases were obtained by 35 cases (10.54%) with the proportion of new cases in syphilis patients by 28 cases (80.0%). Advanced stage syphilis was acquired in 32 cases (91.42%) followed by secondary stage (S-II) in 3 cases (8.58%) and there were no cases of manifestation of primary stage syphilis (0.00%). Based on sex, syphilis sufferers are dominated by women with 22 people (62.85 %%) while male gender is 13 people (37.15%).

Conclusion: Most of the new syphilis cases in Mangusada Regional Hospital, Badung were found at patient visits with STIs, had advanced stage manifestations, and were dominated by female sex.

Latar Belakang: Penyakit kelamin (veneral disease) seperti sifilis sudah lama di kenal di Indonesia. Akan tetapi, manifestasi klinik penyakit sifilis berbeda sesuai dengan tahapannya dimana berdampak pada rencana pengobatan. Oleh karena itu penelitian ini bertujuan untuk mencari tahu gambaran prevalensi sifilis laten, sekunder, dan primer pada pasien Infeksi Menular Seksual (IMS) di Poliklinik Kulit dan Kelamin RSUD Mangusada, Badung.

Metode: Penelitian observasional potong lintang dilakukan terhadap data sekunder dari rekam medis pasien Sifilis di Poliklinik Kulit & Kelamin RSD Mangusada Badung pada Januari 2017-Desember 2018 dengan menggunakan teknik total sampling. Prevalensi Sifilis pada pasien terutama dari jenis kelamin dan manifestasi klinis sifilis dicatat pada peneltian ini. Data yang diperoleh dianalisis secara deskriptif dengan piranti lunak SPSS versi 20 untuk Windows.

Hasil: Total kunjungan kasus infeksi menular seksual (IMS) tercatat sebanyak 332 orang dimana kasus sifilis diperoleh sebesar 35 kasus (10,54%) dengan proporsi kasus baru pada penderita sifilis sebesar 28 kasus (80,0%). Sifilis stadium lanjut diperoleh sebanyak 32 kasus (91,42%) diikuti dengan stadium sekunder (S-II) sebanyak 3 kasus (8,58%) dan tidak terdapat kasus manifestasi sifilis stadium primer (0,00%). Berdasarkan jenis kelamin, penderita sifilis didominasi oleh perempuan dengan jumlah 22 orang (62,85%%) sedangkan jenis kelamin pria berjumlah 13 orang (37,15%).

Kesimpulan: Sebagian besar kasus baru sifilis di RSUD Mangusada, Badung ditemukan pada kunjungan pasien dengan IMS, memiliki manifestasi stadium lanjut, dan didominasi oleh jenis kelamin perempuan.

Analysis of serum albumin levels in pre and post hemodialysis among Chronic Renal Failure (CRF) patients at Dr. Wahidin Sudirohusodo Hospital, Makassar, Indonesia

Background: Chronic renal failure (CRF) is a clinical syndrome caused by a chronic decrease and gradual progression in kidney function. One of the complications of CRF can cause hypoalbuminemia. Hemodialysis can also cause hypoalbuminemia associated with inflammation and malnutrition due to loss of protein during dialysis. This study aims to analyze the albumin levels in pre and post hemodialysis CRF patients in Dr. Wahidin Sudirohusodo Hospital, Makassar.

Methods: A retrospective study with cross sectional study design using secondary data obtained from the medical record was conducted among 50 patients at Dr. Wahidin Sudirohusodo Hospital, Makassar. Pre and post hemodialysis serum albumin levels of CRF patients from the Medical Record Installation were collected during September 2017 – 2018 period. Variables assessed in this study were gender, age, albumin levels, and the comparison of albumin levels based on gender. Data were analyzed using SPSS version 22 for Windows.

Results: There were 52.0% male and 48.0% of female patients in this study. Most of the respondents were age 40-49 years old interval (30.0%). There was no significant difference in albumin levels between pre (3.07±0.63 g/dL) and post (3.05±0.54 g/dL) HD patients (p=0.665). Also, There was no significant difference in albumin levels in pre and post HD patients between male (p=0.434) and female (p=0.778).

Conclusion: There were no significant differences between serum albumin levels pre and post hemodialysis in patients with CRF as well as based on gender.

Hubungan kontrol glikemik dengan petanda gangguan ginjal dini pada pasien diabetes melitus tipe 2

Background: Glycemic control in type 2 diabetes mellitus (DM) which can be assessed by examination of fasting blood sugar (FBG) and glycosylated hemoglobin (HbA1c) is thought to be associated with renal complications. Several markers can be used to assess the rate of damage to early kidney function, such as serum creatinine, urine creatinine albumin ratio (uACR), and serum cystatin C. The relationship of glycemic control with early kidney disorder markers in type 2 DM patients still shows controversial results.. The aim of the study to investigate the relationship between glycemic control (FBG and HbA1c) with early kidney disorder markers (serum creatinine, uACR, and cystatin C) in patients with type 2 diabetes mellitus.

Methods: Analytic observational study with cross sectional approach conducted in April - June 2019 involved 34 type 2 DM patients in Karang Ayu Health Center who met the inclusion and exclusion criteria. Examination of GDP levels using the hexokinase method, HbA1c levels using the HPLC method, serum creatinine using the Jaffe method, uACR is calculated based on the ratio between urine albumin and creatinine, and cystatin C levels using the ELISA method. Statistical tests using Spearman's non-parametric correlation with p <0.05 were considered significant.

Results: The mean ± SD FBG and HbA1c levels were 130.41 ± 39.37 mg/ \dL and 8.21 ± 1.65%. Median (minimum-maximum) serum creatinine levels, uACR and serum cystatin C were 0.63 (0.35-2.79) mg/dL, 16.55 (4.1-29.8) mg/g and 0.72 (0.46 - 1.22) mg/L. The correlation of FBG levels with serum creatinine, uACR, and serum cystatin C were (r = 0.016; p = 0.927), (r = 0.293; p = 0.092), and (r = 0.334; p = 0.053). The relationship of HbA1c with serum creatinine, uACR, and cystatin C was (r = 0.120; p = 0.495), (r = 0.326; p = 0.059); and (r = 0.505; p = 0.002).

Conclusions: There is no relationship between FBG with serum creatinine, uACR, and cystatin C. The HbA1c value is positively related to cystatin C but not related to serum creatinine and uACR in patients with type 2 diabetes mellitus.

Latar belakang: Kontrol glikemik pada diabetes melitus tipe 2 (DM) yang dapat dinilai dengan pemeriksaan gula darah puasa (GDP) dan hemoglobin terglikosilasi (HbA1c) diduga berhubungan dengan komplikasi nefropati. Beberapa petanda dapat digunakan untuk menilai menilai kerusakan fungsi ginjal dini, misalnya kreatinin serum, rasio albumin kreatinin urin (uACR), dan cystatin C serum. Hubungan kontrol glikemik dengan petanda gangguan ginjal dini pada pasien DM tipe 2 masih menunjukkan hasil yang kontroversial. Mengetahui hubungan antara kontrol glikemik (GDP dan HbA1c) dengan petanda gangguan ginjal dini (Kreatinin serum, uACR, dan cystatin C) pada pasien diabetes melitus tipe 2.

Metode: Penelitian observasional analitik dengan pendekatan belah lintang dilakukan pada bulan April - Juni 2019 melibatkan 34 pasien DM tipe 2 di Puskesmas Karang Ayu yang memenuhi kriteria inklusi dan ekslusi. Pemeriksaan kadar GDP menggunakan metode heksokinase, kadar HbA1c menggunakan metode HPLC, kreatinin serum menggunakan metode Jaffe, uACR dihitung berdasarkan rasio antara albumin dan kreatinin urin, dan kadar Cystatin C menggunakan metode ELISA. Uji statistik menggunakan korelasi non parametrik Spearman dengan p < 0,05 dianggap signifikan. 

Hasil: Rerata±SD kadar GDP dan HbA1c adalah 130,41±39,37 mg/dL dan 8,21±1,65%. Median (minimum-maksimum) kadar kreatinin serum, uACR dan cystatin C serum berturut-turut adalah 0,63(0,35-2,79) mg/dL, 16,55(4,1-29,8) mg/g, dan 0,72(0,46 – 1,22) mg/L. Korelasi kadar GDP dengan kreatinin serum, uACR, dan cystatin C serum adalah (r=0,016; p=0,927), (r=0,293; p=0,092), dan (r=0,334; p=0,053). Hubungan HbA1c dengan kreatinin serum, uACR, dan cystatin C adalah (r=0,120; p=0,495), (r=0,326; p= 0,059); dan (r = 0,505; p = 0,002).

Simpulan: Tidak terdapat hubungan antara GDP dengan kreatinin serum, uACR, dan cystatin C. Nilai HbA1c berhubungan positif sedang dengan cystatin C namun tidak berhubungan dengan kreatinin serum dan uACR pada pasien diabetes melitus tipe 2.

Karakteristik kasus otitis eksterna di RSUP Sanglah Denpasar periode April 2015-April 2016

Background: External Otitis (OE) is one of the most common cases in ENT. There are an estimated 8.1 visits with an OE diagnosis per 1,000 annually. The low understanding of the community about OE caused the cases to become frequent. This study aims to increase public understanding of OE by knowing the characteristics of OE in Sanglah Hospital.

Methods: A study with descriptive cross sectional method. Samples were taken from Sanglah Hospital's medical record data on period 2015-2016 with total sampling method.

Results: A total of 84 samples were successfully analyzed, and found: OE was most common in the 15-49 years age group (55.9%). Gender dominating is female (52.4%). The most clinical symptoms of OE patients were ear pain (67.9%), followed by ear discharge (55.9%), ear that felt full (22.6%), itchiness (20.2%), ringing (21.4%), hearing loss (15.5%), and accompanied (4.8%). The most frequent cause of OE is due to trauma (58.3%), followed by fungi or bacterial infection (20.3%), combined causes (11.9%), and the least caused by systemic disease (9.5%).

Conclusions: The OE case at Sanglah Hospital is most commonly found in the female population, age group 15-49 years, with the most common symptom of earache and caused by mechanical trauma.

Latar Belakang: Otitis Eksternal (OE) merupakan salah satu kasus yang sering ditemukan dalam bidang THT. Diperkirakan terdapat 8.1 kunjungan dengan diagnosis OE per 1.000 per tahunnya. Rendahnya pemahaman masyarakat mengenai OE menyebabkan kasus ini menjadi sering terjadi. Studi ini bertujuan untuk meningkatkan pemahaman masyarakat mengenai OE dengan mengetahui gambaran kejadian OE di RSUP Sanglah.

Metode: Sebuah studi dengan metode deskriptif potong lintang. Sampel diambil dari data rekam medis RSUP Sanglah pada periode 2015-2016 dengan metode total sampling .

Hasil: Sebanyak 84 sampel berhasil di analisis, dan ditemukan: OE paling sering terjadi pada kelompok umur 15-49 tahun, (55,9%). Jenis kelamin yang mendominasi adalah perempuan (52,4%). Gejala klinis penderita OE terbanyak adalah nyeri telinga (67,9%), diikuti berair atau keluar cairan dari telinga (55,9%), terasa penuh (22,6%), rasa gatal (20,2%), berdenging (21,4%), gangguan pendengaran (15,5%), dan yang disertai (4,8%). Penyebab OE terbanyak adalah karena trauma (58,3%), diikuti karena jamur atau bakteri (20,3%), penyebab gabungan (11,9%), dan paling sedikit disebabkan oleh penyakit sistemis (9,5%).

Simpulan: Kasus OE di RSUP Sanglah paling sering ditemui pada populasi wanita, kelompok umur 15-49 tahun, dengan gejala tersering berupa nyeri telinga dan disebabkan oleh trauma mekanis.  

Keloid aurikularis dekstra yang diterapi kombinasi eksisi intralesi dan injeksi kortikosteroid dengan anestesi tumesen: sebuah laporan kasus

Introduction: Keloid is a skin lesion due to overproduction of collagen and fibroblasts. Has predilection on high tension skin and there are various modalities in handling them. The purpose of this case report is to provide a perspective of auricular keloids treated by a combination of intralesional excision and corticosteroid injection with tumescent anaesthesia.

Case: A 28-year-old woman who has a history of small nodules on the right ear that is getting bigger and bigger. Dermatological status shows the right auricular helix region obtained nodules brown, solitary, oval shape, size 5x7 cm, firm boundaries, regular edges, smooth surface and shiny. In palpation hard and fixed fixation is found. Patients were treated with a combination of intralesional excision and corticosteroid injection with tumesent anaesthesia. Corticosteroid injection used was triamcinolone acetonide as much as 0.4 cc intra-lesion on the 3rd day. Control on the 7th day the patient was in good condition and did not appear to have any complications with the condition of the post-surgical wound being treated.

Conclusion: Management of auricular keloids by intralesional excision and corticosteroid injection after three days post-surgery provides the satisfactory clinical outcome of keloids.

Pendahuluan: Keloid merupakan suatu lesi kulit oleh karena produksi berlebihan dari kolagen dan fibroblast. Memiliki predileksi pada kuit yang memiliki tegangan tinggi dan terdapat berbagai modalitas dalam penanganannya. Tujuan dari laporan kasus ini adalah memberikan perspektif keloid aurikularis yang diterapi kombinasi eksisi intralesi dan injeksi kortikosteroid dengan anestesi tumesen.

Kasus: Seorang perempuan berusia 28 tahun yang memiliki riwayat bintil kecil pada telinga kanan yang makin lama makin membesar. Status dermatologis menunjukkan regio helix aurikularis dekstra didapatkan nodul berwarna kecokelatan, soliter, bentuk oval, ukuran 5x7 cm, batas tegas, tepi regular, permukaan halus dan mengkilat. Pada palpasi didapatkan kosistensi keras dan terfiksir. Pasien di berikan tatalaksana kombinasi eksisi intralesi dan injeksi kortikosteroid dengan anestesi tumesen. Injeksi kortikosteroid yang digunakan adalah triamcinolone acetonid sebanyak 0,4 cc intra lesi pada hari ke-3. Kontrol pada hari ke-7 pasien dengan kondisi baik dan tidak tampak suatu komplikasi apapun dengan kondisi luka paska bedah yang terawatt.

Simpulan: Penanganan keloid aurikularis dengan teknik eksisi intralesi dan injeksi kortikosteroid tiga hari paska bedah memberikan luaran klinis keloid yang memuaskan.

Profil dermatitis kontak akibat kerja pada pekerja garmen di Kota Denpasar

Background: The development of the garment industry in Bali is increasing as a tourism supporting industry. As a consequence the number of garment and textile companies is growing in quantity and quality. According to data in the Denpasar City, there were around 125 large garment companies employing at least 100 workers. A small garment company as a home industry is almost five hundred. The impact of the development of the garment industry requires a lot of human resources by recruiting, opening jobs both for trained and untrained workers, most of whom are casual workers, without getting attention in terms of health. This research was conducted to collect data about the pattern of skin lesions (work-related contact dermatitis) in garment workers in Denpasar City because they do not have complete and accurate data.

Methods: The method used in this study was a survey on three large garment companies in Denpasar with interviews and examinations of their skin disease patterns.

Results: Total 288 workers included in this study consisted of 105 (36.5%) men and 183 (63.5%) women. From 288 respondents, 74 workers (25.7%) suffer from skin disorders related to their work. The occupational category that suffered the most was colouring workers of 30 people.

Conclusion: The pattern of skin disease in garment workers by 25.7% suffering from DKAK. Disease categories are often workers who come into contact with colour materials.

Latar Belakang: Perkembangan industri garment di Bali semakin meningkat sebagai salah satu industri penunjang pariwisata. Sebagai konsekuensi jumlah perusahan garmen dan tekstil semakin banyak secara kuantitas dan kualitas. Menurut data di kodya Denpasar, tercatat sekitar 125 perusahan garmen yang besar dengan memperkerjakan sedikitnya 100 orang pekerja. Perusahan garmen yang kecil sebagai industri rumah tangga hampir sebanyak lima rastusan. Dampak dari perkembangan industri garment membutuhkan banyak tenaga kerja dengan merekrut, membuka lapangan pekerjaan baik itu untuk pekerja yang terlatih maupun yang tidak terlatih, kebanyakan merupakan pekerja lepas, tanpa mendapat perhatian dari segi kesehatan. Penelitian ini dilakukan untuk mengumpulkan data tentang pola kelainaan kulit pada(DKAK) pekerja garment  di Kodya Denpasar, karena belum memiliki data yang lengkap dan akurat.

Metode: Metode yang digunakan pda penelitian ini adalah survelanse, pada 3 perusahan garment yang besar di Denpasar dengan wawancara dan pemeriksaan terhadap pola penyakit kulitnya.

Hasil: Dari 288 pekerja yang di ikut sertakan dalam penelitian ini terdiri dari 105 (36,5%) laki-laki dan 183 (63,5%) perempuan. Dari 288 responden, sebanyak 74 pekerja (25,7%) yang menderita kelainan kulit yang berhubungan dengan pekerjaannya. Katagori pekerjaan yang paling banyak menderita adalah pada pekerja pencelupan (coloring) sebesar 30 orang.

Simpulan: Pola penyakit kulit pada pekerja garment sebesar 25,7% menderita DKAK. Katagori penyakit sering adalah pekerja yang berhubungan kontak dengan bahan warna.

Penilaian mutu asuhan keperawatan sebelum dan sesudah penerapan clinical pathway di Rumah Sakit Umum Pusat (RSUP) Sanglah, Bali, Indonesia

Background: Hospitals implement clinical pathways in an effort to improve the quality of health services, especially the quality of nursing care. This study aims to determine whether the quality of nursing care after the application of the clinical pathway is better than the quality of nursing care prior to the clinical pathway application.

Methods: This study used 180 inpatient medical records in January 2017-May 2019 with five priority medical diagnoses namely cerebral concussion and epidural hematoma (conservative therapy), conservative treatment of preterm premature rupture of membranes, ablation of atrioventricular nodal reentrant tachycardia (AVNRT) , atrioventricular reentrant tachycardia (AVRT), atrial tachycardia, atrial fibrillation, premature ventricular contractions (PVC), ventricular tachycardia (VT), junctional tachycardia and intracerebral haemorrhage (hemorrhagic stroke) as well as post-Lapastomy frozen section in the selected cystic ovary with a selective curative cyst . The variables studied were the application of clinical pathway, quality of nursing care, quality of assessment, diagnosis, planning, implementation and evaluation of nursing. Data were analyzed with the Pearson Chi-Square Test on SPSS version 17 for Windows.

Results: The quality of good nursing care before and after the application of clinical pathway was 15.2% versus 50.9% (p = 0.00); good quality of nursing assessment before and after clinical pathway application of 6.7% versus 64.9% (p = 0.00); good quality of diagnosis before and after clinical pathway application of 72.7% versus 73.7% (p = 0.889); the quality of the nursing plan which consisted of good quality of goal formulation before and after the application of clinical pathway was 75.8% versus 73.7% (p = 0.759); good quality determination of interventions before and after clinical pathway application of 75.8% versus 79.8% (p = 0.523), good quality of implementation before and after clinical pathway application of 100% versus 100% and good quality of nursing evaluation before and after the application of clinical pathway is 100% versus 100%.

Conclusion: The quality of nursing care and nursing assessment after the implementation of clinical pathway is significantly better than before the implementation of clinical pathway, while no significant difference was found in the quality of diagnosis, planning, implementation and evaluation of nursing.

Latar Belakang: Rumah sakit menerapkan clinical pathway dalam upaya meningkatkan mutu pelayanan kesehatan khususnya mutu asuhan keperawatan. Penelitian ini bertujuan untuk mengetahui apakah mutu asuhan keperawatan sesudah penerapan clinical pathway lebih baik daripada mutu asuhan keperawatan sebelum penerapan clinical pathway

Metode: Penelitian ini menggunakan 180 rekam medis pasien rawat inap pada bulan Januari 2017-Mei 2019 dengan lima diagnosis medis prioritas yaitu cerebral concussion dan epidural hematoma (terapi konservatif), penanganan konservatif ketuban pecah dini preterm, ablasi pada  atrioventricular nodal reentrant tachycardia (AVNRT), atrioventricular reentrant tachycardia (AVRT), atrial takikardi, atrial fibrilasi, premature ventricular contractions (PVC), ventricular tachycardia (VT), junctional takikardi dan intracerebral haemorrhage (stroke hemoragik) serta post laparatomi frozen section pada kista ovarii curiga ganasyang dipilih dengan purposive sampling. Variabel yang diteliti adalah penerapan clinical pathway, mutu asuhan keperawatan, mutu pengkajian, penegakan diagnosis, rencana, implementasi dan evaluasi keperawatan. Data dianalisis dengan Uji Pearson Chi-Square pada SPSS versi 17 untuk Windows.

Hasil: Mutu asuhan keperawatan yang baik sebelum dan sesudah penerapan clinical pathway sebesar 15,2% versus 50,9% (p=0,00); mutu pengkajian keperawatan yang baik sebelum dan sesudah penerapan clinical pathway sebesar 6,7% versus 64,9% (p=0,00); mutu penegakan diagnosis yang baik sebelum dan sesudah penerapan clinical pathway sebesar 72,7% versus 73,7% (p=0,889);  mutu rencana keperawatan yang terdiri mutu  perumusan tujuan yang baik sebelum dan sesudah penerapan clinical pathway sebesar 75,8% versus 73,7% (p=0,759); mutu penentuan intervensi yang baik sebelum dan sesudah penerapan clinical pathway sebesar 75,8% versus 79,8% (p=0.523), mutu implementasi yang baik sebelum dan sesudah penerapan clinical pathway sebesar 100% versus 100% dan mutu evaluasi keperawatan yang baik sebelum dan sesudah penerapan clinical pathway sebesar 100% versus 100%.

Simpulan: Mutu asuhan keperawatan dan pengkajian keperawatan sesudah penerapan clinical pathway secara signifikan lebih baik daripada sebelum penerapan clinical pathway, sedangkan mutu penegakan diagnosis, rencana, implementasi dan evaluasi keperawatan tidak terdapat perbedaan yang signifikan.

Prevalensi sarkopenia dan frailty di desa Pedawe, Mangupura, Serai dan Songan

Background: Frailty is characterized by a decrease in multi-organ physiological functions. Sarcopenia and frailty have a significant impact on individuals and society so it is necessary to know the prevalence in the community. This study aimed to determine the prevalence of sarcopenia and frailty in rural areas

Method: The was a cross-sectional study in the elderly population in the villages of Pedawa, Mangupura, Serai and Songan. Measurement of muscle mass using bioelectrical impedance analysis (BIA) and categorized based on the recommendation of the Asian Working Group for Sarcopenia (AWGS). Frailty is established through a screening questionnaire based on the Cardiovascular Health Study. The study was chosen by simple random sampling and population register data.

Results: The study involved 235 elderly people with 117 people in Pedawe village, 71 people in Mangupura village, 34 people in Serai village and 13 people in Songan village with a composition of 35.5% men and 64.5% women. In this study sarcopenia in women was 51% and men 49%, while frailty was experienced in 58.9% women and 41.02% men. The mean age is 67.7 years. The prevalence of total sarcopenia is 59% with the lowest percentage ranging from the villages of Mangupura (30%), Songan (53.8%), Pedawe (70.9%), and Serai (79.4%). The overall frailty prevalence in the four villages is 17% with the percentage starting from the lowest being Mangupura (1.4%), Serai (5.9%), Songan (22.2%) and Pedawe (29.1%).

Conclusions: The prevalence of sarcopenia and frailty is most common among elderly women. The highest prevalence of sarcopenia was found in Serai village and frailty prevalence was highest in Pedawe village.

Latar Belakang: Frailty ditandai dengan adanya penurunan fungsi fisiologis multi organ. Sarkopenia dan frailty memberikan dampak yang bermakna bagi individu dan bagi masyarakat sehingga perlu untuk mengetahui prevalensinya di masyarakat. Penelitian ini bertujuan untuk mengetahui prevalensi sarkopenia dan frailty di daerah pedesaan

Metode: Penelitian menggunakan studi potong lintang pada populasi lansia di desa Pedawa, Mangupura, Serai dan Songan. Pengukuran massa otot menggunakan bioelectrical impedance analysis (BIA) dan dikategorikan berdasarkan rekomendasi Asian Working Group for Sarcopenia (AWGS). Frailty ditegakkan melalui kuesioner skrining berdasarkan Cardiovascular Health Study. Penelitian dipilih dengan cara simple random sampling dan data register penduduk.

Hasil: Penelitian melibatkan 235 orang lanjut usia dengan jumlah 117 orang di desa Pedawe, 71 orang di desa Mangupura, 34 orang di desa Serai dan 13 orang di desa Songan dengan komposisi 35,5% laki-laki dan 64,5% perempuan. Pada penelitian ini sarkopenia pada perempuan adalah 51% dan laki-laki 49%, sedangkan frailty dialami 58,9% perempuan dan 41,02% laki-laki. Rerata usia adalah 67,7 tahun. Prevalensi sarkopenia total adalah 59% dengan persentase masing-masing mulai dari yang terendah adalah desa Mangupura (30%), Songan (53,8%), Pedawe (70,9%), dan Serai (79,4%).  Prevalensi frailty keseluruhan di empat desa adalah 17% dengan persentase masing-masing  mulai dari yang terendah adalah desa Mangupura (1,4%), Serai (5,9%), Songan (22,2%) dan Pedawe (29,1%).

Kesimpulan: Prevalensi sarkopenia dan frailty paling banyak ditemukan pada lansia perempuan. Prevalensi sarkopenia paling tinggi didapatkan di desa Serai dan prevalensi frailty didapatkan paling tinggi di desa Pedawe.

Perbedaan cost-effectiveness pengangkatan drain kurang dari 3 hari dengan lebih dari 3 hari pada modified radical mastectomy

Introduction: Modified radical mastectomy (MRM) is a therapeutic choice for operable breast cancer. The most frequent post-surgery complication is seroma formation, and this can be circumvented by the use of drainage. There is still a debate over the use of drainage time on the effectiveness and cost efficiency used. The purpose of this study is a more in-depth study of the cost-effectiveness of removing drainage in less than three days with more than three days, in patients post-MRM.

Method: This research is a cost-effectiveness analysis using a decision tree, with a cross sectional analytic research design. Data collection was performed retrospectively by comparing direct medical cost to evaluate the difference in cost-effectiveness of drain removal for less than three days and for more than three days for modified radical mastectomy (MRM).

Results: 36 samples were collected that met the exclusion and inclusion criteria, consisting of 19 samples in the group with drain removal ≤ 3 days, and 17 samples in the group with drain removal> 3 days. Analysis of the cost of removing the drain less than three days showed the average direct medical cost of the patient was Rp. 700,578.00. Whereas patients with drain removal for more than three days showed a direct medical cost of Rp. 981,000.00. The average difference in average cost-effectiveness ratio between the two groups is Rp. 2,599.00.

Conclusion: In this study, patients with drain removal ≤ 3 days had better cost-effectiveness compared to drain removal> 3 days.

Pendahuluan: Modified radical mastectomy (MRM) adalah pilihan terapi pada kanker payudara dapat dioperasi. Komplikasi pasca tindakan yang paling sering terjadi adalah terbentukya seroma, dan hal tersebut dapat disiasati dengan penggunaan drain. Masih terjadi suatu perdebatan terhadap lama pemakian drain terhadap efektifitas dan efisiensi biaya yang digunakan. Tujuan dari penelitian ini adalah pengkajian lebih mendalam tentang cost-effectiveness pada pengangkatan drain kurang dari tiga hari dengan lebih dari tiga hari, pada pasien pasca tindakan MRM

Metode: Penelitian ini merupakan penelitian cost-effectivness analisis menggunakan decision tree, dengan rancangan metode penelitian analytic cross sectional. Pengambilan data dilakukan secara retrospektif dengan membandingkan direct medical cost (biaya medis langsung) untuk mengevaluasi perbedaaan cost-effectiveness pengangkatan drain kurang dari tiga hari dan lebih dari tiga hari pada modified radical mastectomy (MRM).

Hasil: Dikumpulkan 36 sampel yang memenuhi kriteria ekslusi dan inklusi, terdiri dari 19 sampel pada kelompok dengan pengangkatan drain ≤ 3 hari, dan 17 sampel pada kelompok dengan pengangkatan drain > 3 hari. Analisis biaya pada pengangkatan drain yang kurang dari tiga hari menunjukkan rerata direct medical cost pasien adalah Rp. 700,578,00. Sedangkan untuk pasien dengan pengangkatan drain lebih dari toga hari menunjukkan direct medical cost sebesar Rp. 981.000,00. Rerata perbedaan average cost-effectiveness ratio antara kedua kelompok adalah Rp. 2,599,00.

Simpulan: Pada penelitian ini didapatkan pasien dengan pengangkatan drain ≤ 3 hari memiliki cost-effectiveness lebih baik dibandingkan dengan pengangkatan drain > 3 hari.

The relationship between urine specific gravity, urine pH, and blood uric acid levels to the type of urinary stones of patients with urolithiasis at Sanglah Hospital, Bali, Indonesia

Background: Urine specific gravity, urine pH, and blood uric acid levels are risk factors for urinary tract stones. The urinary tract stones are formed due to the concentration of a solute exceeds its ability to remain in solution, resulting in supersaturation and crystallization. This study aims to determine the relationship between urine specific gravity, urine pH, and blood uric acid levels to the urinary stone's types in patients with urolithiasis at Sanglah Hospital

Methods: A retrospective cross-sectional study was conducted among 95 subjects by using secondary data from the medical records in the period June 2017-2018 at Sanglah Hospital. The urolithiasis patient who met the inclusion and exclusion criteria were enrolled in this study. Data were analyzed by the Mann-Whitney Test and Kruskal-Wallis Test using SPSS version 17 for Windows.

Results: The average age was 55±11 years old. Most of respondents were male (70.5%), normal Body Mass Index (BMI) (89.5%), urine pH <7 (75.7%), and mixed type of urinary stones (48.4%). There was a statistically significant relationship between the type of uric acid stone (p=0.029), blood uric acid levels (p=0.003), phosphate stone type (p=0.026), and magnesium stone (p=0.010) with urine pH. Besides, there was a statistically significant relationship between ammonium stone and blood uric acid levels types (p=0.022). A statistically significant difference was also found between stone types based on urine pH (p=0.013) in multivariate analysis.

Conclusion: There is a significant relationship between urine pH and stone type on the incidence of urolithiasis in Sanglah Hospital in June 2017-2018, thereby increasing the incidence of urolithiasis.

Pola sidik jari (Dermatoglifi) sebagai metode skrining diagnostik Sindrom Down pada anak

Background: Fluorescence in Situ Hybridization (FISH) or complete chromosomal examination (karyotyping) is an examination of the gold standard in the diagnosis of Down syndrome, but it is quite expensive, so not all people in the society can use it. The purpose of this study was to determine the differences between the mean frequency of dermatoglyphics occurrence patterns and to determine the level of sensitivity and specificity of dermatoglyphics diagnostic tests on people with Down Syndrome.

Methods: The method used in this study was observational analytic with a cross sectional study on 28 children who have Down syndrome derived from SLB C Negeri Tuna Grahita and 28 normal children of primary school 14 Dauh Puri. Data analysis using Independent T-test, a diagnostic test with sensitivity and specificity parameters was conducted by Receiver Operating Characteristic (ROC) curve. Data were analyzed using SPSS version 17 for Windows.

Results: The results showed that on average, the highest percentage fingerprint patterns in people with Down syndrome are ulnar loops with a mean 6.39, whereas in normal children is a whorl with a mean 2.25. The diagnostic test, ulnar loop pattern, has the highest degree of accuracy with a cut-off=4 followed by sensitivity value 1 (0.87 to 1) and a specificity 1 (0.87 to 1).

Conclusion: There are differences in the frequency of occurrence of fingerprint patterns in children with Down syndrome and normal children, as well as the patterns of the ulnar loop has the highest accuracy rate of sensitivity and specificity of the diagnostic test.

Latar Belakang: Fluorescence in Situ Hybridization (FISH) atau pemeriksaan kromosom lengkap (kariotyping) merupakan pemeriksaan baku emas dalam penegakan diagnosis sindrom Down, namun tergolong mahal sehingga tidak semua lapisan masyarakat mampu menggunakannya. Tujuan penelitian ini adalah untuk mengetahui perbedaan rerata frekuensi kemunculan pola dermatoglifi serta untuk mengetahui tingkat sensitivitas dan spesifisitas uji diagnostik dermatoglifi terhadap penderita sindrom Down.

Metode: Metode yang digunakan pada penelitian ini adalah observasi analitik dengan studi potong lintang terhadap 28 anak yang mengalami sindrom Down didapat dari SLB C Negeri Tuna Grahita dan 28 anak normal dari SD Negeri 14 Dauh Puri. Analisis data menggunakan uji analisis T tidak berpasangan dan uji diagnostik dengan parameter sensitivitas dan spesifisitas menggunakan Reciever Operating Characteristic (ROC). Data dianalisis dengan SPSS versi 17 untuk Windows.

Hasil: Hasil penelitian menunjukkan bahwa rata-rata persentase tertinggi pola sidik jari pada penderita sindrom Down adalah loop ulnar dengan nilai mean 6,39, sedangkan pada anak normal adalah whorl dengan nilai mean 2,25. Dalam uji diagnostik, pola loop ulnar memiliki tingkat akurasi tertinggi dengan cut off=4 diikuti nilai sensitivitas 1 (0,87-1) dan spesifisitas 1 (0,87-1).

Kesimpulan: Terdapat perbedaan frekuensi kemunculan pola sidik jari pada anak dengan sindrom Down dan anak normal, serta pola loop ulnar memiliki tingkat akurasi sensitivitas dan spesifisitas tertinggi dalam uji diagnostik.

Gambaran pemeriksaan serologi, darah lengkap, serta manifestasi klinis demam berdarah dengue pasien dewasa di RSUP Sanglah Denpasar periode Januari sampai Desember 2016

Background: A serological test of anti-dengue, complete blood count (CBC), and clinical manifestations routinely assesed in patients with dengue hemorrhagic fever (DHF).

Aim: This study aimed to determine the description of the serological test, the CBC test, and clinical manifestations of DHF.

Method: Research design used cross-sectional descriptive study with the non-experimental retrospective method, using medical records data of adult DHF patients at Sanglah Hospital Denpasar. The sample of the study was adult DHF impatient from January to December 2016.

Result and Conclusion: Of the 110 samples, the study revealed 71 (65%) men and 39 (35%) women. As from serology, 16 (14,5%) primary infection and 94 (85,5%) secondary infection were detected. CBC test results in both primary and secondary infections showed variative value. Some of the variables with the highest number of samples in abnormal value were thrombocytes (decreased, 100% both primary and secondary infection), as against in leucocytes (decreased, 81.25% in primary infection, 48.94% in secondary infection). Haematocrit is normal for both infections. Clinical manifestations were varied such as fever and torniquet (+) are most prominent (100% both primary and secondary infections), the most prominent bleeding is in the gums (75% in primary infection, 57.69% in secondary infection), and the other clinical sign such as hepatomegaly, pleural effusion, hypoalbuminemia, cold skin, restlessness, and shock were rare observed.

Latar Belakang: Pemeriksaan serologi anti dengue, darah lengkap, dan klinis mutlak dilakukan pada pasien demam berdarah dengue (DBD).

Tujuan: Penelitian ini dilakukan untuk mengetahui gambaran pemeriksaan serologi, darah lengkap dan manifestasi klinis.

Metode: Rancangan penelitian descriptive cross-sectional dengan metode retrospektif non-eksperimental, menggunakan data rekam medis pasien DBD dewasa di RSUP Sanglah Denpasar. Sampel penelitian adalah 110 pasien DBD dewasa rawat inap periode Januari-Desember 2016.

Hasil dan Kesimpulan: Dari 110 sampel didapatkan 71 (65%) laki-laki dan 39 (35%) perempuan. Dari pemeriksaan serologi, didapatkan 16 (14,5%) pasien infeksi primer dan 94 (85,5%) infeksi sekunder. Hasil pemeriksaan darah lengkap baik pada infeksi primer maupun sekunder menunjukkan semua variabel memiliki nilai yang bervariasi. Beberapa variabel dengan jumlah sampel paling banyak pada nilai tidak normal yaitu trombosit (menurun, 100% baik infeksi primer maupun sekunder), leukost (menurun, 81,25% pada infeksi primer, 48,94% pada infeksi sekunder), hematokrit cenderung normal pada kedua infeksi, manifestasi klinis yang bervariasi, demam dan torniquet (+) yang paling menonjol (100% baik infeksi primer maupun sekunder). Selain itu, perdarahan yang paling menonjol adalah pada gusi (75% pada infeksi primer, 57,69% pada infeksi sekunder). Klinis lain seperti hepatomegali, efusi pleura, hipoalbuminemia, kulit dingin, gelisah dan syok jarang teramati.

Efektivitas multi drug therapy pada transmisi morbus hansen transplasental

Introduction: The evidence of transplancental transmission of Morbus Hansen (MH) in animal models is a challenge for MH treatment in pregnancy because it brings anxiety for patients and their fetuses. 

Case: A 31-year-old pregnant woman, first trimester, came with complaints of reddish numbness rash on her hands since 2 years ago. Dermatological examination showed erythematous plaque, multiple, well-defined, irregular borders with hypoaesthesia. There were right and left ulnar nerve enlargement. Acid Fast Bacteria (AFB) from ear lobes and lesion revealed Bacterial Index +2 and Morphological Index 10%. Histopathological examination showed gren zone which indicate MH type BL. Patient was diagnosed with MH Multi Basiler (MB) on G3P2002Ab000 and given MDT MHMB. Postpartum IgM and IgG anti-PGL-1 examination of cord blood and infant blood, also PCR examination of cord blood and amnion showed negative results. Histopathological examination found no AFB on the umbilical cord and placenta. 

Conclusion: MDT is effective in preventing transplacental transmission of MH from mother to fetus.

Tatalaksana peritonitis bakteri Staphylococcus Epidermidis pada seorang pasien dengan continuous ambulatory peritoneal dialysis (CAPD)

Background: Peritonitis is a common CAPD related infection. It can cause discontinue dyalisis peritoneal and conversion to hemodyalisis.

Case description: This article reported a 54-year-old man on 5 years dialysis peritoneal with a complaint of abdominal pain since 1 week before admission. The complaint accompanied by fever and nausea. On abdominal examination there are mild distention, weak of bowel sound, pressure pain, and defans muscular. Dialisat examination found cloudy fluid, effluent white blood cell count 961 cells/mm³ composed of 85% polymorphonuclear leucocytes. Peritoneal dialysis effluent gram stain, routine culture found isolated Staphylococcus epidermidis with methicillin resistant, significant as infectious agent depend on patient’s clinical and infection’s marker. Performed a definitive antibiotic with Linezolid 600 miligram intravena and Gentamicin 40 miligram intraperitoneal during 14 days showed clinical and laboratorium improvement.

Conclusion: Peritonitis remains a major cause of technique failure in peritoneal dialysis and affects patient’s morbidity and mortality. Management should be definitive antibiotic as dialysat culture result. Catheter removal indicated if there were refractory peritonitis, relapsing peritonitis, refractory exit-site and tunnel infection, fungal peritonitis.

Latar belakang: Peritonitis merupakan komplikasi infeksi pada pasien CAPD yang umum terjadi. Peritonitis dapat menjadi penyebab utama penghentian dialisis peritoneal dan dikonversi ke hemodialisis.

Deskripsi kasus: Laporan kasus ini melaporkan laki-laki berusia 54 tahun yang telah menjalani CAPD selama 5 tahun mengeluh nyeri perut sejak 1 minggu yang lalu SMRS. Nyeri perut disertai dengan demam dan mual. Pemeriksaan abdomen didapatkan distensi ringan, bising usus terdengar lemah, adanya nyeri tekan, dan defans muskuler. Pemeriksaan analisis cairan dialisat didapatkan warna keruh/berawan dengan jumlah  961 sel/uL dengan dominan polymononuklear sebesar 85%. Pemeriksaan kultur/ biakan cairan peritoneum didapatkan terisolasi bakteri Staphylococcus epidermidis yang bersifat Methicillin resistant, significan sebagai agen penyebab infeksi tergantung keadaan klinis dan marker infeksi pasien. Dilakukan tatalaksana terapi antibiotik definitif dengan Linezolid 600 miligram setiap 12 jam intravena dan Gentamicin 40 miligram intraperitoneal, intermiten dose saat penggantian cairan malam hari. Pemberian terapi antibiotik definitif dan intraperitoneal dilanjutkan selama 14 hari dan pada pasien didapatkan perbaikan secara klinis dan laboratorium.

Simpulan: Peritonitis merupakan penyebab utama kegagalan teknik pada dialisis peritoneal dan mempengaruhi morbiditas serta mortalitas pasien CAPD. Diagnosis peritonitis terkait CAPD sedini mungkin serta pemberian terapi yang cepat dan tepat dapat menghindarkan pasien dari komplikasi yang lebih berat dan kegagalan dialisis peritoneal.